You're healthy enough to live in your own apartment, but perhaps you still need help with your medications or with bathing. If you'd like the added benefits of a full social life and meals in a comfortable dining room, an assisted-living facility may be a good fit.
But navigating the assisted-living maze can be a challenge. Some facilities house as few as ten seniors in a home-like setting, while others house as many as several hundred in a high-rise building. Care services can vary as well: Facilities may offer physical therapy or skilled nursing—or provide little care at all. Even the names differ from place to place: adult homes, retirement residences, board and care, and congregate care.
Regulatory oversight also varies by state, leading to quality problems at some facilities. Issues range from outright abuse to medication errors. "I'm seeing some excellent quality of life and quality of care in assisted living, but we see some serious problems as well," says Alice Hedt, Maryland's long-term-care ombudsman.
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Given the disparity in quality and services, prospective residents and family members must conduct their own due diligence before choosing a facility. That means visiting several places, reading the fine print of residential agreements, and asking numerous questions of managers, aides and residents.
One million Americans live in assisted living—a midway point between independent living and a nursing home. Typically, residents lease apartments—from a studio to a two-bedroom—by the month and eat in a common dining area. Facilities also offer health care monitoring, and residents can engage in recreational and fitness activities. Even if a person doesn't need much daily attention, "they benefit from the overall support—not having to cook, social contact, someone to notice if something is wrong," says Suzanne Modigliani, a Brookline, Mass., geriatric-care manager.
After a stroke at age 80, widower Donald Campbell could manage fairly well at first but needed some help with eating and household chores, says daughter Elizabeth Campbell of Denver. "He could no longer stay at home, but didn't need nursing-home care," she says. Her father moved from North Carolina to an assisted-living community near her home and lived there for nearly five years before he died in 2008.
When her father became ill, Elizabeth Campbell didn't have much time to check her options. She visited several nearby facilities, relying on gut feelings. "Most of the places I went to didn't feel good," she says. Although her father was comfortable at the facility she chose, Elizabeth says she wishes she had consulted a local geriatric-care manager for guidance and an elder-law attorney to sort out "a lot of the technicalities."
For instance, says Rye Brook, N.Y., elder-law attorney Michael Amoruso, contracts could give "the landlord more rights than tenants in terms of eviction," compared with typical rental agreements. Another legal issue: If an adult child without a power of attorney signs an agreement on behalf of the parent, the child could be financially liable.
Ask the Right Questions
When you start your quest, look only at facilities with a state license. Ask each center for its agreement outlining services, prices, extra charges and staffing. "Ask how much help is available, at what time and to what level," Modigliani says. Facilities may differ on the amount of help they can offer with using the toilet, eating and other activities of daily living, for example. Seniors who have a particular concern with falling should make sure they can get extra help while they're dressing or bathing. Make sure all special requirements and wishes, including favorite social activities, are documented in a personal-care plan.
Eat a meal, and ask whether there are menu choices. Also note if staff members are attentive and kind to residents. Speak with residents and their visiting family members about their experiences.
Find out about the training the center provides for its staff, and make sure the facility conducts criminal background checks on employees. Because of low wages, turnover is typically high industry-wide. Compare the turnover levels for each center as well as the staff-to-resident ratio.
Still, there are no hard-and-fast rules on staff levels. "Assisted-living communities are staffed based on the level of care and service needed by the residents," says Jamison Gosselin, a senior vice-president of the Assisted Living Federation of America. For example, he says, there will be fewer caregivers per resident in a community that "serves a pretty independent group of seniors" than at one where residents need more assistance.
Review the contract's provisions on the facility's discharge policies. After a resident leaves for a stint in a hospital or rehabilitation, the facility will decide whether the resident can return. The resident could be charged for food or other services if she's gone for an extended period. "Even for death, a resident may owe a few months," Modigliani says.
Because assisted-living arrangements don't provide around-the-clock skilled-nursing care, they typically run about half the cost of nursing homes. In 2011, the national average "base rate"—a one-bedroom unit, at least two meals a day, housekeeping and minimal personal-care assistance—was $3,477 a month, according to the MetLife Mature Market Institute.
But costs vary widely. Most facilities offer several pricing tiers, each with its own set of services. A resident needing little assistance would be at the lowest tier, or base price. You will need to find out what services are included in each tier, such as the number of meals each day, and how much it will cost if your relative needs more care in the future.
As her father's needs grew over five years, his monthly costs rose to $6,000, from the initial $3,000, says Elizabeth Campbell. Eventually, her father needed help dressing and managing his medicines, and took his meals in his apartment. Because Medicare doesn't pay assisted-living costs, most residents pay the entire tab out of pocket. Elizabeth says her father's long-term-care insurance policy covered most of the costs.
Regulatory oversight varies by state. Ask to review complaints made to state agencies, as well as all state-inspection reports. For information on your state's regulatory agency, contact the Assisted Living Federation of America (www.alfa.org; 703-894-1805). You can also find a state's ombudsman at the National Long-Term Care Ombudsman Resource Center (www.ltcombudsman.org; 202-332-2275).
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